Aa
Aa
A
A
A
Close
2150739 tn?1336482645

Need Answers

Facts:
I am 22 y/o female with tachycardia/ chest pain/ shortness of breath
Not a smoker, drinker or drug user
Healthy (no other health issues)

Problems:

When I move, walk, cough my heart rate jumps into the 140-170's. This has been going on for 3 years but my primary doctor would not refer me to see a cardiologist. I finally have been admitted into my local hospital since they cannot find what it wrong. I was on beta blockers for a couple years and still had palpitations & chest pain.  ( Atenenol, Metropolol,Propranolol)

While on Metropolol I had a seizure because it dropped my bp to low.

I stopped taking the beta blocker and my symptoms stayed the same. It seemed as if on medicine or off medicine they did not go away.

I came in to the hospital Wed 5/2 with a HR of 130-160 that lasted 5 hours. They have done an echo (came back perfect), stress test (HR went to 200 with minimal exertion, nuclear stress test (came back perfect). However, when the nurse walks me on my floor it will jump into the 170's and cause SVT.

The cardiologist, wanted to try medicine first ( I am on Bisoprolol) I still am connected to my monitor and the heart rate is jumping. He said that the problem is that it is tachycardia but my waves have a normal pattern. He said that he believes I have "inappropriate sinus tachycardia". I want to believe this diagnosis however, I feel that there is more that can be done. The local electrophysiologist cannot do the EP study for my issue. The Cardiologist mentioned an alcohol ablation but he said that it is a last resort. I am frustrated because if they can fix the problem now while I am young why don't they? This is tachycardia does not allow me to work out, drive or anything. It comes and goes when it wants and it interferes with my everyday life. Does anyone have any suggestions?

The nurses have all indicated that because of my age they are not as aggresive. But, if I was a doctor and had a young healthy patient with these complaints I would be more concerned. I feel like everyone pushes heart disease prevention however when I try to get help there is nothing done.

Is there a series of test that have to be done before an EP study? All the internal medicine doctors are saying to have the EP study but the cardiologist I am seeing will not allow me to have one. He says to try it last.


8 Responses
Sort by: Helpful Oldest Newest
875426 tn?1325528416
Just what do they mean by EP study?  An electrophysiologist is the proper kind of cardiologist to try to figure out what is wrong with your heart's electrical system!  I hope you are able to get your monitor results to the electrophysiologist and that they will be willing to take you- in my opinion, you already have sufficient evidence for a referral to the EP to try to figure out what is wrong.
Helpful - 0
2150739 tn?1336482645
Thank you for all your feed back. I was discharged and sent home, waiting on my monitor. The cardiologist I am seeing spoke with the EP doctor and they need more evidence to do the EP study. They are not exactly sure if i have IST, that was a guess because my heart ekg sometimes mimics IST but it will also go into SVT.

It is rare but we did get it recorded on the EKG. It feel like they are taking this slowly because they have never had someone like me have this condition.

I do not have any diseases, drug abuse or any other issue. I am healthy in every-way except for this issue.  They are going to monitor the E-tach monitor and then compare it to my discomfort when we meet. Then, they will send me to Gainsville to see a specialist that does the ablation I would need. (Alcohol Ablation)

This is just frustrating because i live in an area where the majority of patients are 75 +. So, they are not familiar with younger adults and heart problems, disease or arrhythmia's.
Helpful - 0
1398166 tn?1358870523
I would probably get a second opinion on the EP study.
You have good and proper insurance? Otherwise, I can't imagine why they would be giving you the run around. Ablation is expensive ($75,000-ish) and will tap that policy pretty hard. If you're on an HMO, I could see them "managing" the condition as drugs are cheap.
Helpful - 0
875426 tn?1325528416
I want to make a further recommendation.  Find a better cardiologist than the one you've been seeing.  An electrophysiology study should not be a last resort after treatment has been tried.  It should be used as a diagnostic tool to help determine a course of action for you.  You might even see if your internal medicine doctor would refer you directly to a cardiologist who IS an electrophysiologist for proper diagnosis through thorough testing.
Helpful - 0
875426 tn?1325528416
Beta blockers were not an effective treatment for my own P.O.T.S. however.  I later had a cardiologist recommend I not take any kind of blood pressure medication because he felt they would just make me feel worse.

Additionally, with P.O.T.S. being one of those conditions you describe at the end (stressing the body & cardiovascular system), I've had both low and high blood pressure with it, as well as lab test spikes in catecholamine and their inactive metabolite forms from it, but not high enough for pheochromocytoma to be the culprit suspected.

It was interesting that you mentioned atrioventricular and sinus tachycardia, and I did a little research.  I verified IST can mimic AV tachycardia on e-medicine- interesting, I did not know that before!  The origin of the heart beat, of course, with IST is from the correct electrical node, versus the latter having the heartbeat originating from an abnormal source.  With these modern EKG machines that do their own automatic readings, a person would think the machines should pick up on these differences?  

It would appear Sinoatrial reentrant tachycardia, a focal atrial tachycardia subset has a morphology of P wave and atrial activation sequence identical or quite, quite similar to sinus tachycardia, but it's most common  in structural heart disease and complex heart disease patients as well as especially after surgery involving atrial incisions or scars.  
Helpful - 0
1124887 tn?1313754891
Inappropriate sinus tachycardia can be difficult for the doctors to differ from atrial tachycardia (a subtype of SVT) just by seeing the EKG. If the SVT origin from a spot close to (but not in) the sinus node, they can look similar, so the SVT can mimic a sinus tachycardia.

Without being able to give you an answer, (we are not doctors), it sounds like your blood pressure possibly can have something to do with your condition (I assume it's low as you had seizures from taking a beta blocker). Low blood pressure can give the exact symptoms you describe. There are other beta blockers (non-cardiac selective beta blockers) that don't affect the blood pressure as much as the selective (metoprolol, bisoprolol, atenolol) do, because non-selective beta blockers constrict the blood vessels to a certain degree. Non-selective beta blockers are treatment for POTS, by the way.

Also, conditions like chronic stress, infections, etc. must be ruled out if they aren't already.

Your blood pressure is maybe sort of the key here. If it is high, you may have conditions stressing your body and cardiovascular system (adrenaline emitting tumors, hyperthyroidism, etc), if it is low, your heart may have to go into tachycardia to compensate.
Helpful - 0
875426 tn?1325528416
You say you have SVT but the cardiologist it looks like claims you have sinus tachycardia, not supraventricular tachycardia.  If you have SVT, they might consider an ablation if medicinal and lifestyle changes are not controlling the situation, but ablation is NOT recommended if you have IST (what your cardiologist thinks you have) or P.O.T.S..  

P.O.T.S.,  which is short for postural orthostatic tachycardia syndrome,  means your pulse increases by more than 30 beats per minute standing versus lying down (tests for P.O.T.S. include a standing norephinephrine test which if you have it comes out with over 600, if I remember right, and a positive tilt table test for the syndrome. (I did not get the blood test, but was diagnosed with a positive tilt table test conducted by an electrophysiologist.)

If you also are heaving headaches and sweating and having spikes in blood pressure, ask for plasma free metanephrine testing to rule out a rare catecholamine-emitting tumor called a pheochromocytoma.  

Please consider joining the dysautonomia forum, where a number of us with IST and POTS post?
http://www.medhelp.org/forums/Dysautonomia-Autonomic-Dysfunction/show/266
Helpful - 0
612551 tn?1450022175
COMMUNITY LEADER
I agree with your goal of finding a cure, and the best time to do it is while you are young.  The young part will hold for a number of years yet, so it could be reasonable/wise to try less intrusive (medication) first.

However, you say your condition is a big negative on your quality-of-life and that is one of the drivers for taking some risk.  I bring up the word "risk" regardless how small it is something your doctors would minimize, and that's good.

From what you've included in your post, I say again I agree with your goal, just keep working on it with your doctors.  Be sure they understand you are not able to function/live with the condition.
Helpful - 0
Have an Answer?

You are reading content posted in the Heart Rhythm Community

Top Arrhythmias Answerers
1807132 tn?1318743597
Chicago, IL
1423357 tn?1511085442
Central, MA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Are there grounds to recommend coffee consumption? Recent studies perk interest.
Salt in food can hurt your heart.
Get answers to your top questions about this common — but scary — symptom
How to know when chest pain may be a sign of something else
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.